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9 Mar 2010 : Column 172

Mr. Burrowes: Is there any prospect of any change from this Government to the decision to downgrade Chase Farm hospital's consultant-led A and E and maternity services despite more than 100,000 attendances at A and E and more than 3,300 births at the hospital?

Mr. O'Brien: We are looking with great care at all the various proposals and Chase Farm hospital is the subject of one of those proposals in London. The issues are supposed to be locally driven, locally led and locally determined reconfigurations. The hon. Gentleman and his party seem to think that this is all coming from Whitehall, but that is complete nonsense. These are local decisions, locally arrived at.

Jeremy Corbyn (Islington, North) (Lab): I thank my right hon. and learned Friend for his reply to my hon. Friend the Member for Islington, South and Finsbury (Emily Thornberry). The overwhelming case for retention of the Whittington A and E has been made and continues to be made, but we discover that officials from the north central London NHS review are still working on a plan that we believe involves closure of the A and E, and they will not publish that plan for several months. Will he ensure that all the plans are published now so that the public can see what is being thought up by officials?

Mr. Mike O'Brien: If my hon. Friend will forgive me, I want to return to the various discussions that have taken place, the minutes and the proposals being circulated. Engaging with clinicians, and how we engage with them, is important.

Lynne Featherstone (Hornsey and Wood Green) (LD) rose-

Mr. O'Brien: I will give way to the hon. Lady, but then I want to make some progress.

Lynne Featherstone: I welcome the Minister's remarks because, as he knows, the socio-demographic circumstances around Whittington hospital make the area one of the most deprived in London. My concern is that, of the seven current options, four suggest closing the accident and emergency department. That seems to be a huge waste of resource and energy when the money is needed in front-line services. Will he talk to north central London officials now and stop the process, because, as the hon. Member for Islington, North (Jeremy Corbyn) said, the case has been made for retention of the A and E department?

Mr. O'Brien: I hear what the hon. Lady says, but if she reads my comments just now and listens carefully, she will realise that, in a sense, I have addressed some of those points already.

Mrs. Villiers rose-

Mr. O'Brien: If the hon. Lady will forgive me, I need to make some progress; many people want to speak in the debate.

I do not mind the hon. Member for South Cambridgeshire taking the view that he does not like the Darzi process of clinically led, locally driven decisions made through a local process. He can object to that. We have set out a broad-based approach, and a decision-making
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process, as a result of a review by clinicians. I do not mind him objecting to that, and he is perfectly at liberty to do so-it is a matter of debate-but I find it bizarre that his alternative is no alternative. It is a "Stop the bus, I want to get off" approach. He is saying, "There are lots of inequalities in London, and lots of issues that need to be addressed, but I'm not going to address them because they are in the 'too difficult' category."

For decades, reconfiguring London to deliver better services has been in the "too difficult" category for too many Governments. Virginia Bottomley attempted to do it, but got hammered for it, because it was not clinically led. As a result, Londoners have put up with a worse service than many other parts of the country. Decisions about changing the NHS are difficult, and people are attached to local provision and fear changes. After the Thatcher period, they fear that the agenda is about cutting provision, not about making it better.

Going back decades, Governments-Labour and Tory-have failed. In 2006, NHS London asked Professor Ara Darzi-now Lord Darzi-to set out a vision for change in London: a process for bottom-up, clinically led improvements, the aim of which was to drive up the quality of services, not to make cuts. Because Ara Darzi was an eminent consultant-not a politician or a manager-clinicians bought into the process. They accepted his bona fides and his work to improve provision, and they engaged in the difficult process of change.

Discussions about possible reconfiguration have taken place across London- [Interruption.] Yes, they have, and clinicians are still engaged today, but they will not be if the Conservatives get in, because they will stop that process. Clinicians are engaged in a variety of meetings-this comes back to a point raised earlier-considering options and discussing them among themselves before making proposals through an iterative process of asking, "What are the best proposals for each area?" This is about clinicians discussing what is best for London.

Those proposals are already out for consultation in north-east London, and elsewhere they are still being discussed and weighed up. Local people will be engaged when there are clear proposals. They will be bottom-up, not Whitehall-led, proposals from the local NHS, not Ministers. That does not mean that it will not be difficult-the proposals raise concerns-but it means that clinicians concerned about quality services are leading the process. The key Darzi components can be summarised as localised services where possible, and centralised services where it is necessary for patient safety.

That is the process that the Conservative party is attacking and saying that it would do away with. Its motion identifies the problem in London, but rejects the bottom-up reconfiguration that clinicians say is needed to save lives. Instead, the Conservatives would dump the Darzi process, opportunistically attack every output from it and every attempt to allow clinicians the space to discuss what would work, play on the fears of local people, and, most damagingly and opportunistically of all, offer no real process to replace it.

Joan Ryan rose-

Mrs. Villiers rose-

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Simon Hughes (North Southwark and Bermondsey) (LD) rose-

Mr. O'Brien: I will give way to the hon. Gentleman in a moment.

The NHS changes are difficult, and they do raise local concerns. If there is a real alternative to what we are doing-if the hon. Member for South Cambridgeshire had come up with anything other than saying, "Let the GPs decide from their funding what they want to keep and what they do not"-then I missed it. He did not come forward with any such alternative: it is not in his motion and it was not in his speech.

Let us have a look at the motion. There is a vague call for something called a

Yes, good-got that. Indeed, Darzi attempts to do just that, but if the hon. Gentleman does not accept the Darzi process, what will he put in its place? A policy of no-change conservatism is not a serious policy. It does not deal with the inequalities that the hon. Gentleman set out. People are now dying and getting poor health treatment because Governments in the past have found the problem too difficult. We are now making some of the changes that are needed. In the face of that, the Conservatives abdicate responsibility, advocate nothing to replace the Darzi process and play to public fears. That is what is happening. If they do that in government, the inequalities that the hon. Gentleman has identified will remain, because he has no approach to deal with them. All he wants to do is play Pontius Pilate, washing his hands of the problem and saying, "Well, we wanted something done-there were real inequalities-but it was up to the GPs locally."

Simon Hughes: Does the Minister realise that the reason why a lot of people are fearful and suspicious is that they have recent memories of reorganisations? The Tories proposed, and Labour then agreed, to the closure of the A and E unit at Guy's hospital, for example. Money has been allocated to primary care trusts in deprived areas such as Southwark, but it has then been top-sliced and taken away, even though we were meant to need and deserve it. I can tell the Minister that we have wards in hospitals across the river from this place, including in Guy's, that are absolutely full and overstretched-and not full of "not ill" people, but full of seriously ill people who need to be in hospital, not treated by their GP.

Mr. O'Brien: It is the case that Government funding for the NHS has, of course, increased massively over the past decade, as the hon. Gentleman well knows. [ Interruption. ] It has increased, and it is also the case that London has received substantial amounts of additional funding, and will continue to do so this year and the next. We need to ensure that that money is spent in the best way possible, so that we deliver the best quality of services and deal with the inequalities in London. At the moment that has to be done by engaging clinicians in a serious process of looking at what works and at how we can change the services, so that we address those inequalities effectively.

My concern is about the intellectual hole in the Opposition's policy. They would end the process that we
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have set up, and although I think that they genuinely want to will the end of having to deal with inequalities, I just do not think that they have any means to deliver that-they have not come up with anything, anyway. Frankly, from what I can see in the speech by the hon. Member for South Cambridgeshire, their priority is marginal seats, not saving lives. Their worry is about parliamentary candidates, not stroke victims. If they offered an alternative, there would be a debate, but how can we debate with someone who offers no alternative but to return the health of London to the "too difficult" column? That is what the hon. Gentleman is doing: no courage, no leadership, and, most worryingly for a possible alternative Government, no vision for how to solve the health problems of London.

Let me explain why we believe that London must change and how that can be done.

Mr. Slaughter: Will my right hon. and learned Friend give way?

Mr. O'Brien: I will, and then I will make some more progress.

Mr. Slaughter: My right hon. and learned Friend correctly identifies the fact that the Opposition speech was about politics, not health. There was a certain irony in the hon. Member for South Cambridgeshire (Mr. Lansley) denouncing scaremongering by the Liberal Democrats, but then entertaining every piece of scaremongering from those on his own Benches, including, in relation to north-west London, the complete fabrication that hospitals in the Imperial College Healthcare NHS Trust will close, which the hon. Member for Hammersmith and Fulham (Mr. Hands) used in order to get elected five years ago-he said that the hospital was going to close, but it is bigger and better resourced than ever. Will my right hon. and learned Friend confirm that there are no plans-

Madam Deputy Speaker (Sylvia Heal): Order. Interventions are to be brief.

Mr. O'Brien: Our former right hon. Friend, Keith Bradley, found that a campaign was run about a supposed hospital closure in Manchester, and he lost his seat. These are potent arguments, and I can see that opportunistic politicians might run scare stories. That is what is being done. We are trying to undertake the serious process of addressing some of the very inequalities mentioned in the motion on which Opposition Members are going to vote. We have clear proposals for dealing with them, but the hon. Member for South Cambridgeshire has no such proposals at all.

Eleven out of 32 London boroughs are classified as spearhead areas. They are the most deprived areas with the greatest need, and the case for change is clear. Money is not enough, but it certainly helps. Over the past decade, there has been unprecedented extra funding. As a result, the number of people waiting more than 26 weeks for in-patient care has fallen from 48,849 in 1997 to two in January 2010. That is still two too many, but it is a staggering achievement. In January, only three
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people waited more than 13 weeks for an out-patient appointment. That figure is down from 43,639 when we came to power.

The NHS in London has come a long way by having more money. Money alone is not enough, but it helps. This year, the PCTs in London will receive £13.2 billion. Next year, they will get £13.9 billion. The hon. Gentleman asked what we got for that money. There are 45,000 more staff in the London NHS than there were in 1997, and I should just mention that there are 3,000 more consultants, 18,000 more nurses, 1,500 more midwives, and 4,000 more doctors in training. I have a long list, but before I get completely carried away, I shall give way to my right hon. Friend the Member for Enfield, North (Joan Ryan).

Joan Ryan: The Minister will know that Chase Farm hospital is a very good and much-loved, much-needed hospital. The changes to the hospital were decided on before, and outside, the Darzi review. We know that the Conservatives have said that they would make no commitments. They are hypocritical in criticising changes while making no commitment to do anything different. In the light of the achievement of a 24-hour doctor-led service for 2013, will the Minister agree to meet me to discuss further why it is so important to keep an ambulance service at the accident and emergency department at Chase Farm hospital?

Mr. O'Brien rose-

Madam Deputy Speaker: Order. I understand that the temperature is rising on both sides of the House, but may I advise Members to be aware of their language and, in particular, of the use of the word "hypocritical"?

Mr. O'Brien: I am very happy to meet my right hon. Friend to discuss ambulance provision and to look at the way in which the services in her area are being dealt with. She has spoken to me on many occasions about the issue, and I am familiar with her local circumstances. She is also right to say that the hon. Member for South Cambridgeshire can give no real commitments on these issues. After all, if he is going to rely on the local PCTs-all 31 of them-in London to make decisions locally, and if the only extra funding is to come from GPs' budgets, he is not going to be in a position to make any commitments on anything, is he?

We, on the other hand, are making a commitment to an increase of £700 million at a time of financial restraint. Why? Because Labour prioritises the NHS. London now has the biggest hospital building programme in the history of the NHS, with 28 new schemes worth £1.8 billion already open to patients, and another three, worth £1.2 billion, under construction. The Royal London, with a £1 billion scheme, serves some of the poorest communities in London. University College hospital's scheme is worth £422 million. King's College hospital's is worth £76 million. The scheme at Lewisham hospital is for £72 million, and Guy's and St. Thomas's is for £50 million. These are massive enhancements from Labour for London.

In the community, the NHS local improvement finance trust scheme has led to 45 new developments in London, worth £371 million. Gracefield Gardens centre in Streatham, the Barkantine in Tower Hamlets, which I have visited,
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the Heart of Hounslow practice, and Alexandra Avenue health and social care centre in Harrow are all shining examples of the results of our investment in the health of our capital. All offer extended opening hours to patients; all offer a wide range of community services in addition to GPs; and all are delivering what patients tell us they want the NHS to do for them-local services in their local area.

Today, advances in medicine and technology mean that more and more patients can be treated and cared for in the area. We need to ensure that the type of care services people get are those that they need. That means change. It is not about freezing services in aspic, as the hon. Member for South Cambridgeshire suggests he can do-it takes vision, not the policy of NHS do-nothingism. The NHS in London can continue to do better for the people of London. That is why we have set out the Darzi agenda to make some of these changes.

Across the city, the NHS is looking at how best to implement this programme for improving the health and lives of Londoners. It is already concentrating specialist care in centres of excellence. Londoners who suffer heart attacks are now taken straight to the specialist care they need in one of eight heart attack centres, significantly improving their chances of recovery. Creating that was not easy; it took tough decisions. If we had left it to local PCTs, we would not have had a process. It is because we created the Darzi process that changes were made, addressing local fears rather than stoking them up for votes.

Last year, a joint committee of all PCTs in London agreed to new stroke and trauma networks based on that model, which will save hundreds of lives. That was fully endorsed by a joint overview and scrutiny committee of all 32 London boroughs, including the Conservative authorities. London's PCTs have invested £20 million in improving stroke care. In the coming months, eight new hyper-acute stroke units will open and standards will be up to the best in the world.

We are in the process of creating in London a world-class NHS, whereas the hon. Member for South Cambridgeshire has a "do nothing" view of the NHS, which will change little or nothing. We also have three new trauma centres, which will be open by April, and that of St. Mary's is to open in October.

Ten new polyclinics are open, all of which are receiving excellent feedback from patients. An evaluation project is under way to ensure that the local NHS learns lessons so that the model of care can be improved and rolled out across the capital. By the end of the next financial year, another 20 will be in place. Following Lord Darzi's review, the challenge for local areas is to improve services in the most appropriate way for their communities.

Mr. Duncan Smith rose-

Mr. O'Brien: If the right hon. Gentleman will forgive me, I have said that others want to speak. I want to make progress as I need to get through my argument. After that, I may give way to him.

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